COMMENT. PRES, also referred to as hypertensive encephalopathy or reversible posterior leukoencephalopathy syndrome, is a clinical syndrome that results from disruption of the blood-brain barrier and vasogenic edema, demonstrated on MRI with hyperintense signals in the posterior cerebral white matter.

PRES in an infant 35 days old is reported from the Mayo Clinic. The syndrome is rare in children less than 1 year. The infant had a history of obstructive sleep apnea, laryngomalacia, and choanal atresia. While undergoing bronchoscopy, she developed apneic episodes with stiffening of extremities. EEG revealed occipital lobe onset seizures, and MRI showed hyperintense T2 signal in both posterior temporal and parieto-occipital lobes. A labile blood pressure was normalized and seizures abated with fosphenytoin and levetiracetam. At 3 month of age, resolution of MRI abnormality confirmed the diagnosis of PRES. [2]

PRES and risk of epilepsy. The incidence of subsequent epilepsy was 2.25 fold higher in patients with hypertensive encephalopathy (HE) than in controls, in a nationwide population-based study in Taiwan. The incidence of epilepsy was higher in men, younger patients with HE, and in those with brain disorders. [3]